These are the most difficult warts to remove. Peel away the keratotic tissue and apply a concentrated phenol solution. Follow this with an application of nitric acid, and cover it with a salicylic acid plaster and adhesive bandage. Repeat this treatment every 5 days; it normally takes from three to seven treatments for complete resolution. Patients may be referred to a dermatologist for other wart removal techniques, such as freezing and elect rosurgical or surgical excision.
Impetigo
This is a superficial staph or strep skin infection.
SYMPTOMS—Normally lesions consist of small pustules, but they may be larger with rupturing and crusting. The lesions may remain localized but are often autoinoculated over large areas. It is most commonly found in children. Impetigo may appear on apparently healthy skin, but sometimes complicates other skin infections.
TREATMENT—Topical antibiotics will normally result in prompt resolution. Gentle but thorough washing to remove any crust and debris should precede the application of ointment. If left untreated, impetigo may result in cellulitis or furunculosis. These complications should be treated with systemic antibiotics.
Furuncles and Carbuncles
A furuncle (boil) is an acute tender inflammation around perifollicular areas that is caused by staphylococci. Carbuncles are goups of furuncles adjacent to one another.
SYMPTOMS—A furuncle has a single core of necrotic tissue. The core exudes a purulent fluid and is most commonly found on the neck, axillae, and buttocks. These lesions are extremely painful. A carbuncle has two or more cores with multiple drainage sites and deep suppuration. There may be extensive sloughing of the tissues with large scar formation. A fever may be present and the patient is often prostrated. Carbuncles occur more frequently in men.
TREATMENT—A single furuncle should be treated with moist heat to facilitate pointing. Once it has pointed, incise and attempt to remove the central core. Implant an iodoform pack to promote drainage and to prevent premature healing. Systemic antibiotics are indicated. Large furuncles and carbuncles require special care in debridement to avoid spreading the infection. Refer severe cases to a dermatologist.
Cellulitis
This is a spreading inflammation of the tissues, which usually affects the skin and subcutaneous tissues. Streptococcus and staphylococcus are the causative agents.
SYMPTOMS—These include fever, chills, malaise, headache, acute pain upon palpation, and swollen, red, and warm areas. Regional lymphangitis or lymphadenitis is common. Severe cases will often result in septicemia or bacteremia.
TREATMENT—Place the affected part at rest and elevate. Bed rest is indicated if the condition is severe. Apply moist heat and administer erythromycin or lincomycin systemically. Continue the treatment until the symptoms have ceased for 5 days.
Folliculitis
This condition is the result of a staphylococcal infection of hair follicles. Sycosis barbae is a chronic and recalcitrant type better known as barber’s itch. It appears in the bearded area and is aggravated by shaving.
SYMPTOMS—Burning and itching are common, and manipulation of hair causes pain.
TREATMENT—Apply hot packs to the affected area. Apply topical antibiotics, and give systemic antibiotics if the areas around the eyes, nose, or mouth are involved (dangerous triangle).
Tinea Capitis
Ringworm of the scalp is a highly contagious fungal infection usually affecting school children.
SYMPTOMS—It is characterized by small gray lesions in which the hair is broken off, scant, or without luster. It may involve all or a part of the scalp.
TREATMENT—Griseofulvin is definitive and 0.5 g should be administered twice daily with meals for 4 to 8 weeks or a single dose of 2 to 6 g repeated every 3 to 4 weeks.
